Malignancy In Solitary Thyroid Nodule Research Articles

Frequency of Malignancy in Solitary Thyroid Nodule in a Tertiary Level Hospital of Bangladesh

Objectives: To determine the frequency of thyroid malignancy in clinically and sonographically solitary thyroid nodule in patients undergoing thyroidectomy in Comilla Medical College Hospital. Methods: A cross sectional study was carried out at the Department of Otolaryngology and Head Neck Surgery of Comilla Medical College Hospital during the period from January 2016 to January 2019. This study includes all patients admitted and undergoing surgery with solitary thyroid nodule. Results: Out of 188 patients 146 patients were female and 42 patients were male with female:male ratio of 3.4:1. Out of 188 patients 24 patients were found histologically thyroid malignancy. Among them 14 patients were male and 10 patients were female. Papillary carcinoma was found in all cases. Conclusions: Follicular carcinoma is rare in our country. Histopathological examiners may not efficiently be doing their job to differentiate carcinoma from adenoma.

A clinical study of incidence of malignancy in solitary thyroid nodule in a tertiary care hospital

Background: Thyroid nodules are common endocrine problem. A discrete swelling in an otherwise impalpable gland is termed as solitary nodule of thyroid. Solitary nodules have a high likelihood of being malignant. They should be characterized properly for optimum management. Aim of the study is to identify the incidence of malignancy in solitary nodule thyroid.Methods: A prospective study had been carried out from January 2018 to October 2018, in the Department of General surgery, ACS Medical College and Hospital, Chennai, India. Fifty patients, who presented with solitary thyroid swelling were examined clinically and confirmed after taking a detailed history and underwent thyroid surgery were included in this study. The histopathological reports were evaluated by standard statistical methods.Results: There were 50 cases of clinically detected solitary thyroid nodule with female preponderance more than males. The mean age of the incidence of solitary thyroid nodule is 35years. The incidence of malignancy in solitary thyroid nodule is 20%.Conclusions: It is concluded from the present study that 20% of solitary thyroid nodules are malignant, with female preponderance and a mean age of solitary thyroid nodule is 35years.

Added value of strain elastosonography in prediction of malignancy in solitary thyroid nodule

Aim and objectivesTo evaluate the diagnostic accuracy of elastosonographyin prediction of malignancy in solitary thyroid nodule. Methodology60 patients (37 females and 23 male) with solitary thyroid nodule were included, their age ranged from 21 to 52 years (mean age 30.6 years), grey scale, color-power Doppler US and elastography were performed for all patient. ResultsPresence of hypoechogenicity, absent halo sign, irregular margins, microcalcifications and predominant intranodular vascularity were the most US patterns predictive of malignancy. Suspicious nodule by elastography (Astria score 3 and 4) were found in 19 nodules (31.7%), 9 of them were benign and 10 of them were malignant with sensitivity 58.82%, specificity 79.07% and accuracy 73.33%, combined suspicious US findings (TIRAD 4&5) and suspicious elastography score (3&4) were most predictive of malignancy which was found in 16 out of 17 nodules with sensitivity 94.12%, specificity 76.74% and accuracy 81.67%. ConclusionCombined gray scale, color Doppler US and elastography were more sensitive and accurate than US features alone in prediction of malignancy of solitary thyroid nodules with sensitivity 94.12%, specificity 76.74% and accuracy 81.67%.

Malignancy in Solitary Thyroid Nodules: Evaluation of Risk Factors

Background: The aim of the present study was to evaluate patients with suspicious solitary nodules undergoing bilateral total thyroidectomy for the presence of malignancy. Patients and Methods: 141 patients with true solitary thyroid nodules who underwent bilateral total thyroidectomy at the Dr. Abdurrahman Yurtaslan Ankara Oncology Hospital between 2008 and 2013 were retrospectively evaluated. Parameters including demographics, ultrasonographic findings, and laboratory values were analyzed. Results: When the final pathology results were evaluated, malignancy was found in 52/141 (36.9%) patients. 49 (94.2%) of these lesions were papillary carcinoma. Colloidal nodules accounted for 30.3% of all benign cases. Nodular irregularity, increased vascularity, microcalcification, and central/lateral lymphadenopathy significantly increased the risk of malignancy. Among these factors, increased vascularity was the most important risk factor and microcalcification the second. Nodule size did not affect the risk of malignancy. Conclusion: Irregular borders, microcalcification, increased vascularity, and detection of cervical lymphadenopathy were found to be correlated with malignancy in solitary nodules.

Solitary thyroid nodule: Diagnostic yield of combined diffusion weighted imaging and magnetic resonance spectroscopy

AimThe scope of this study is to evaluate the combined application of MR-DWI and MRS in differentiating between benign and malignant thyroid nodules. Materials and methodsTotal of 42 patients was enrolled in this study. DWI was done and ADC values were calculated. MRS was done and Choline peak as well as Cho/Cr ratio was evaluated. ResultsPatients were categorized into benign group (28 patients) (20 adenomatous nodules and 8 follicular adenomas) and malignant group (14 patients: 8 papillary carcinomas, 4 follicular carcinoma, 1 medullary carcinoma, and 1 anaplastic carcinoma).The mean ADC values of benign nodules showed significantly high values than malignant ones (1.84±0.36 versus 0.87±0.35×10−3mm2/s respectively (p<0.0001).While no significant difference was detected among the ADC values of different benign lesions among different malignant pathological types.By analyzing the ROC curve, the area under the curve (AUC) was (0.97) with ADC cutoff value of 1.5×10−3mm2/s was able in differentiating benign and malignant thyroid nodules with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 85.7, 89.2, 80.0, 92.5% respectively while KAPPA test=0.73 and p<0.0001.All malignant thyroid nodules had a significant choline peak (n=14, 100%) at MR spectroscopy (Figs. 2 and 3) while benign nodes showed choline peak in only two cases (n=3, 10.7%).The mean Cho/Cr ratio showed significant higher values in malignant thyroid nodules compared to the benign ones (3.1±0.85 versus 1.09±0.13) (p=0.001).While no detected significant difference of Cho/Cr ratio among different types of malignancy (2.86±0.66, 2.95±0.90, 4.21 and 4.53 for papillary carcinomas, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma respectively, p=0.85).The MRS sensitivity, specificity PPV and NPV in differentiating between benign and malignant thyroid nodules were as following 100, 89.3, 82.4 and 100% respectively while Kappa test was 0.84 and p<0.0001. Combination of both DWI and MRS showed higher diagnostic values than each of DWI and MRS alone with sensitivity, specificity, PPV and NPV of 100, 96, 93.3 and 100% respectively while Kappa test was 0.94 of and p value <0.0001. ConclusionCombination of DWI and MRS techniques can help in the differentiation between benign and malignant solitary thyroid nodules.

English

BACKGROUND AND OBJECTIVES: Solitary nodule of thyroid has increased in incidence in the present day as compared to two decades before. Because of possibility of malignancy, some clinicians especially those in surgical subspecialties recommended that all nodules have to be removed. This study aimed to determine the propotion of solitary nodule of thyroid in general population and in relation to age and sex, the propotion of solitary nodule of thyroid turning out to be multi-nodular goiter, the propotion of euthyroid, hyperthyroid or hypothyroid states in patients presenting with solitary nodule of thyroid, to study the role of FNAC in the management of solitary nodule of thyroid and to determine the incidence of neoplastic and nonneoplastic conditions as a cause of solitary nodule of thyroid in Govt. Royapettah Hospital, Chennai. METHODS: This prospective study includes 50 patients, presenting in Govt. Royapettah Hospital, Chennai who were clinically diagnosed as solitary nodule of thyroid between November 2014 to September 2015. All patients were admitted and were subjected to thyroid profile, USG and FNAC. All patients were operated appropriately depending on the FNAC report. Histopathological examination of the operated specimen was done for all the patients. Depending on the histo-pathological report appropriate postoperative therapies were administered to all the patients and all the patients were followed up appropriately. RESULTS: Commonest presentation of solitary thyroid nodule was asymptomatic. The peak incidence of solitary nodule was observed in 3rd to 5th decade, constituting 60% of the cases studied. Females predominated in number over males in occurrence of solitary nodule in ratio of 1:5.25. 33% of all clinically solitary nodule turned out to be multi-nodular goiter. The common causes of solitary nodule was MNG (26%),follicular adenoma (24%),adenomatous goiter(24%). 95% 0f cases presented with euthyroid state. Incidence of malignancy in solitary thyroid nodule was 18%. Male to female ratio in case of malignant nodule was1:5. Incidence of carcinoma in males presenting as solitary nodule was higher (16.67%) compared to that of females (10.20%). The most common cause of malignancy was papillary carcinoma (55%) followed by follicular carcinoma (45%). INTERPRETATION AND CONCLUSION: Solitary nodule of thyroid is more common in 3rd to 5th decades. Solitary nodule of thyroid are more common in females. Most of the patients presenting with solitary nodule of thyroid are euthyroid and only a small percentage of patient with toxicity or hypothyroidism . USG can be accurately used to detect patients with multinodulary goiter who clinically present as solitary nodule of thyroid. Common causes of solitary nodule of thyroid are MNG, follicular adenoma and adenomatous goiter. Incidence of malignancy in male patients presenting with solitary nodule of thyroid is more when compared to female. The most common cause of malignancy in solitary nodule is papillary carcinoma followed by follicular carcinoma.

Diffusion-weighted MRI and apparent diffusion coefficient in differentiation of benign from malignant solitary thyroid nodule

ObjectiveThe aim of this study was to assess the ability of DWI and ADC to differentiate benign from malignant solitary thyroid nodule. Patients and methodsThis prospective study was done on 60 patients with solitary thyroid nodule. DW- MRI was performed on all subjects at b values of 0, 500 and 1000mm2/s. The mean ADC values of solitary thyroid nodules were measured for b values of 500 and 1000s/mm2. ResultsThe ADC value of benign solitary thyroid nodules ranged from 1.56 to 2.28×10−3mm2/s (b=1000s/mm2) and from 1.64 to 2.70×10−3mm2/s (b=500s/mm2). The ADC value of malignant solitary thyroid nodules ranged from 0.54 to 1.47×10−3mm2/s (b=1000s/mm2) and from 0.61 to 1.56×10−3mm2/s (b=500s/mm2). The mean ADC value for malignant nodules was significantly lower than that for benign nodules (P=0.000). ADC value of 1.5×10−3mm2/s was used as a cutoff value for differentiation of benign from malignant thyroid nodules. ConclusionsDWI is a powerful tool for the differentiation of benign and malignant nodules and for assessing the functional activity of the thyroid gland, and ADC at b-1000 is more accurate in evaluation of solitary thyroid nodule in comparison with b-500.

Diagnostic accuracy of the combined use of conventional sonography and sonoelastography in differentiating benign and malignant solitary thyroid nodules

ObjectiveTo assess the diagnostic accuracy of combined use of conventional grayscale US and sono-elastography in differentiating benign and malignant solitary thyroid nodules. Materials and methodsThis prospective study included 50 patients with solitary thyroid nodules being evaluated using grayscale US followed with sono-elastography (USE). Suspicious conventional sonographic data for malignancy then evaluated using USE were classified according to Rago criteria with calculation of strain ratio. The diagnostic performances of grayscale US, elastography with Rago criteria, for predicting thyroid malignancy were compared and cutoff value for strain ration was statistically analyzed. Finally all patients with solitary nodule were subjected to US-guided FNAC and 35 patients recommended for surgery in the form of 12 patients underwent total thyroidectomy and 23 patients underwent thyroidectomy with neck dissection. Results30 females (60%), and 20 males (40%) were included (Mean age 38) with final diagnosis comprised 29 (58%) pathologically proved benign thyroid nodules and 21 (42%) pathologically proved malignant nodules. US showed significant relation between markedly hypo-echogenicity, oval than tall, margin irregularity, presence of micro-calcification with diagnosis of thyroid malignancies with p value <0.001. Regarding sonoelastography, there was significant relation between elastography scores 4 and 5 and thyroid malignancies showing sensitivity of 80%, a specificity of 100%, and p value <0.001. The most accurate strain ratio cutoff value among studied cases was 2.52. Combination of grayscale US and sono-elastography yielded better results with sensitivity of 92%, specificity of 95%, PPV of 89%, NPV of 92% and diagnostic accuracy or efficacy of 96%. ConclusionCombined use of USE and grayscale US, showed superior performance in the differentiation of malignant and benign thyroid nodules compared with each technique alone. Suspicious US criteria with elasticity Rago scores 4 and 5 and strain ratio more than 2.52 are the most predictive signs of malignancy.

Study of Immunohistochemical Markers (CK-19, CD-56, Ki-67, p53) in Differentiating Benign and Malignant Solitary Thyroid Nodules with special Reference to Papillary Thyroid Carcinomas.

Solitary Thyroid Nodule (STN) has provoked increased concern owing to higher incidence of malignancy. The inter and intra observer variation in the histomorphological diagnosis of Papillary Thyroid Carcinomas (PTC) may sometimes pose a diagnostic difficulty. This study was undertaken to analyse immunohistochemical (IHC) markers (CK-19, CD-56, p53, Ki-67) to differentiate between benign and malignant surgically resected STN along with their utility in the identification of PTC. The present cross sectional study was conducted over a period of 4 years. A technique of manual tissue array was employed for cases subjected to IHC. The primary antibodies used were CK-19, CD-56, p53 and Ki-67. Analysis of the expression of IHC markers (p53, Ki-67) to distinguish between benign and malignant STN was done. Evaluation and correlation of expression of IHC markers (CK-19, CD-56) to determine its utility in reaching definitive diagnosis and assessing prognosis of PTC was tried. Results were subjected to statistical analysis. The results were considered to be significant when the p-value <0.05. Out of the 160 cases of surgically resected STN specimens, 68 cases were non-neoplastic, 24 cases were benign and 68 cases were of malignant tumours (7 cases of follicular carcinoma (FCa), 61 cases of PTC). CK-19 was found to be a sensitive (83.61%) and a highly specific positive marker (100%) for the diagnosis of PTC. The difference in CD-56 expression between PTC and non-PTC group was found to be highly statistically significant. CD-56 was found to be a sensitive (85.86%) and specific (82.25%) negative marker in differentiating PTC from follicular lesions/neoplasms. The difference in p53 expression between the malignant and non-malignant STN cases was found to be highly statistically significant with a sensitivity and specificity 85.29% and 70.65% respectively. The statistical difference in mean Ki-67 Labeling Index (LI) was found to be significant between PTC versus FA, PTC versus non-neoplastic lesions, FA versus FCa and FVPTC versus FA. The panel of four IHC markers (CK-19, CD-56, p53, Ki-67) may be used for differentiating doubtful benign STN cases from malignant ones and also for definitive diagnosis of PTC along with histopathological examination.

Incidence of malignancy in solitary thyroid nodules.

This study aimed to investigate the prevalence and clinical significance of solitary thyroid nodules in patients who underwent thyroid surgery. A retrospective review was performed of the case notes of all adult patients who underwent thyroid surgery from January 2003 to December 2009. All patients with solitary thyroid nodules identified by ultrasonography were included. In total, 225 patients underwent thyroid surgery. The prevalence of solitary thyroid nodules was 27.1 per cent (61 out of 225 patients). Seventy-two per cent of patients were women and the mean age at presentation was 52 ± 16 years. In all, 75.4 per cent of solitary nodules had neoplastic pathology and the malignancy rate was 34.4 per cent. The sensitivity and specificity of fine needle aspiration cytology for neoplasm detection were 73.9 per cent and 80.0 per cent, respectively. There was no association between the various ultrasonography parameters and malignancy risk (p > 0.05). Solitary thyroid nodules should be investigated thoroughly with a high index of suspicion because there is a high probability (34.0 per cent) of malignancy.

Frequency of Malignancy in solitary Thyroid nodule and Multi-nodular Goitre

This cross sectional study with purposive sampling based on 50 cases of solitary thyroid nodule and multi-nodular goitre for operation in department of Otolaryngology and Head-Neck surgery of SSMC &amp; Mitford Hospital, Dhaka and Dhaka Medical college, Dhaka during January 2009 to December 2009. Objectives of this study to find out relative frequency of malignancy in solitary thyroid nodule and multi-nodular goitre (by histopathology). Each case was studied by history taking, physical examination and relevant investigations. In this series, male to female ratio was 1:7. Mean age of the patients of nodular goitre was 36.5+12.33 years and the highest number of patients were found in age group 31-40 years. After operation, histopatholoical report analysis was done and found that nodular colloidal goitre was 52%, follicular adenoma was 24% and auto-immune thyroiditis was 6%. Among the malignancies papillary carcinoma was 66.66%, follicular carcinoma was 22.22% and anaplastic carcinoma was 11.11%. The relative frequency of malignancy in solitary thyroid nodule was 28% and in multi-nodular goitre was 8%. As there is a chance of malignancy is high so it should get serious medical attention DOI: http://dx.doi.org/10.3329/bjo.v20i2.22019 Bangladesh J Otorhinolaryngol; October 2014; 20(2): 55-59

The accuracy of ultrasonography and fine needle aspiration cytology in the diagnosis of nodular goitre: A prospective analysis of fourty two cases

Aims: -The aim of the present study is to evaluate the accuracy of ultrasonography and fine needle aspiration cytology (FNAC) in diagnosis of thyroid nodules in comparison with other diagnostic modalities and to make early and accurate differentiation of benign and malignant thyroid nodules with incidence of malignancy in thyroid nodules. There is 4-5 % incidence of clinically apparent thyroid nodules in the general population. The majority (90%) of thyroid nodules are benign as malignancy occurs in only 1 in 10 thyroid nodules. The overall incidence of malignancy in solitary thyroid nodule ranges between 10% and 30%. Material and Methods: -A prospective study was carried out on 42 cases with nodular goitre attending the surgery OPD, NKP Salve Institute of Medical Science & Research Centre and Lata Mangeshkar Hospital, Digdoh Hills, Hingna Road, Nagpur from October 2010 to October 2012. All patients were subjected to USG and FNAC. Results: -In this prospective study of 42 cases with nodular goitre, clinically 29 patients had solitary thyroid nodule and 13 patients had multinodular goitre. Out of these 42 patients 35 (83.33%) were female and 7 (16.67%) were male with ratio of 5:1, the age of the patients ranged from 18 years to 65 years. Out of these 29 patients of solitary thyroid nodule, 5 patients had malignancy on histopathological examination. So the incidence of malignancy in clinically solitary thyroid nodule was found to be 17.24%.It was observed that USG was 71.43% sensitive and 90.62% specific in detection of malignancy in nodular goitre whereas FNAC was 75% sensitive and 100% specific in the same regard. Conclusion: -The sensitivity and specificity of these diagnostic modalities were evaluated and it was found that USG and FNAC have a high specificity.No investigation was found to be 100% accurate in diagnosing malignancy in nodular goitre but a combination of various diagnostic modalities (ultrasonography and FNAC) rather than any single modality will give optimal results and avoid unnecessary surgery in a great number of patients without missing any malignancy.

Malignancy in solitary thyroid nodule: A clinicoradiopathological evaluation.

Background:Thyroid nodules are common. They can be either benign or malignant. Solitary thyroid nodules (STN) have a high likelihood of being malignant. They should be characterized properly for optimum management.Materials and Methods:In this study, we have analyzed our departmental data over a period of 5 years. All the patients who presented to the outpatient department with a clinically detected STN were included in the study group. Our approach was individualized. Preoperative ultrasonography (USG) and fine-needle aspiration cytology were planned in all these patients. Hemi thyroidectomy and total thyroidectomy with and without neck dissection were performed wherever appropriate.Results:There were 162 cases of clinically detected STN. USG findings were available in 146 cases. Postoperative histopathology was reported as malignant in 58 cases. Malignant STN was more likely in males. Ultrasonographically detected solid STN were more prone for malignancy as compared to multinodular goiter (P = 0.000) Presence of micro calcification and cervical lymphadenopathy were more commonly noted in malignant thyroid swellings.Conclusion:Solitary thyroid nodules do have a high likelihood of harboring a malignancy. Solid echogenicity, micro calcification and cervical lymphadenopathy on USG were seen more frequently in malignant nodules.

Can real-time ultrasound elastography using the color score and strain ratio differentiate between benign and malignant solitary thyroid nodules?

BackgroundSolitary thyroid nodule may represent a multitude of thyroid disorders; therefore, detection of whether these nodules are benign or malignant is crucial for patient’s triage. ObjectiveTo evaluate the diagnostic performance of the latest generation of real-time ultrasound elastography (USE) in differentiation between benign and malignant solitary thyroid nodules. Materials and methodsThirty consecutive patients who were referred for surgical treatment were prospectively examined by real-time USE. Tissue stiffness on real-time USE was determined with light compression using the standard elastography color scoring system according to Rago criteria ranging from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). The strain ratio (normal tissue to lesion strain ratio) was calculated. The histopathological examination of these resected nodules was used as the diagnostic standard of reference. ResultsScores of 1 and 2 with Rago criteria were highly significant seen in benign nodules, whereas, scores of 4 and 5 with Rago criteria were highly significant seen in malignant nodules (p<0.001) with a sensitivity, specificity and diagnostic accuracy of 78.6%, 78.9% and 78.8% respectively. Additionally, the best strain ratio cut-off value for discrimination between benign and malignant nodules by using receiver operating characteristic analysis was 2.20 (area under the curve of 0.861; p value <0.001) with a consequential sensitivity, specificity and diagnostic accuracy of 85.7%, 90.5% and 88.6% respectively. ConclusionBoth the color score and the strain ratio are higher in malignant solitary thyroid nodules than those in benign ones. Consequently, real-time USE can be used for the differentiation of benign and malignant solitary thyroid nodules. Eventually, this reduces the number of superfluous surgical procedures on benign thyroid nodules.

Histopathological pattern of malignancy in solitary thyroid nodule

Objective: To find out relative frequency and type of malignancy in solitary thyroid nodule (STN).Methods: This cross sectional study done in the Department of Otolaryngology Head &amp; Neck Surgery, Dhaka Medical College Hospital (DMCH), Dhaka and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of July 2008 to June 2009. For this study, 118 patients who were admitted a case of solitary thyroid nodule for operation. Diagnosed the case by detailed history, clinical examination, investigations, analyzed data presented by various tables, graphs and figures. Total 118 patients were selected as per described criteria from the Department of otolaryngology and head-neck surgery DMCH &amp; BSMMU, Dhaka from July 2008 to July 2009.Results: In this study of 118 patients of STN, majority of the patients were within 21-40 years age group with female predominance. In thyroid malignancy male and female ratio was 1:1.75. Among 118 cases of solitary thyroid nodule 22 cases were malignant. Out of 22 malignant cases, 16(73%) were papillary carcinoma, 4(18%) were follicular carcinoma and 2(9%) were anaplastic carcinoma. Thyroid swelling was the common presentation in all cases (100%), some patients also presented with other symptoms like cervical lymphadenopathy in 6 (5.08%) cases, dysphagia 2(1.69%) cases and hoarseness of voice 1(0.85%) case. Study showed very significant difference (p &lt;0.01) between papillary and follicular carcinoma, highly significant difference (p&lt;0.001) between papillary and anaplastic carcinoma. So, papillary carcinoma was more common among all thyroid malignancies in patients with solitary thyroid nodule.Conclusion: Significant proportion of solitary thyroid nodule (18.65%) was malignant. So, careful assessment of thyroid nodule is important for early diagnosis.DOI: http://dx.doi.org/10.3329/bjo.v18i1.10407Bangladesh J Otorhinolaryngol 2012; 18(1): 5-10

FNAC OF THYROID NODULE

Introduction: Clinically, solitary thyroid nodules are common, being present in up to 50% of the elderly population. The majority are benign with thyroid cancer representing an uncommon clinical problem. If euthyroid, then fine needle biopsy provides direct specific information about the cytology of the nodule from which the histology can be inferred. Objectives: To determine the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of solitary thyroid nodule and to avoid unnecessary surgery. Material and Method: Setting: This study was conducted in the Department of Surgery, Sheikh Zayed Medical College/ hospital Rahim Yar Khan. Duration of Study: September 2008 to August 2009 (one year). Sample Size: Fifty patients were included in the study. Study design: Prospective analytical study. Results: The results obtained were compared with histopathology and efficacy of FNAC was checked by calculating sensitivity, specificity, positive predictive value and negative predictive value. Out of 50 cases, FNAC showed 43 cases as benign and 7 cases as malignant lesions, while histopathological examination revealed 42 benign and 8 malignant lesions. FNAC was able to correctly pick 41 benign lesions, while 2 cases of benign lesion turned out to be malignant on histopathology (False negative).Out of total 8 cases which turned out to be malignant onhistopathology, FNAC was able to pick 6 cases, while one benign lesion was misdiagnosed as malignant (false positive). The analysis of study showed a sensitivity of 75% and specificity 97.6% of FNAC in detecting malignancy in solitary thyroid nodule. Conclusions: This study concluded that FNAC is highly effective in detecting thyroid malignancy in solitary thyroid nodule with a sensitivity of 75% and specificity of97.6%.

SOLITARY THYROID NODULE

Objectives: To determine frequency of malignancy in solitary thyroid nodule. Design: Case-series study. Place and Duration of Study: The study was conducted at Department of Surgery, Combined Military Hospital Rawalpindi, from April 2002 till April 2003. Patients and Methods: Sixty patients with clinical solitary thyroid nodule fulfilled the selection criteria and were included in the study. Thyroid function tests, ultrasonography and thyroid scanning was done. Finally FNAC and histopathology were done in all the operated cases and record was evaluated. Results: Out of 60 cases studied, 8 (13.33%) were found to have malignant lesions. The remaining 52 (86.67%) cases had benign pathology. Male patients with solitary thyroid nodule showed a higher incidence of malignancy 17.65% as compared to females 11.63%. Maximum malignant cases (50%) were found between the ages of 31 to 40 years. Papillary carcinoma was the most common malignancy (50%)found in our study. Conclusions: The incidence of malignancy in solitary thyroid nodule is quite high (13.33%). So people should be educated to attend thyroid clinics for early diagnosis and adequate treatment.

Diagnostic Value and Cost Considerations of Routine Fine-Needle Aspirations in the Follow-Up of Thyroid Nodules with Benign Readings

Fine-needle aspiration (FNA) is the most accurate tool to identify malignancy in solitary thyroid nodules. Although some recommend routinely repeating FNA for nodules that are initially read as benign, there is no consensus. We evaluated clinical relevancy and considered costs of routine follow-up FNA in nodules initially read as benign. We reviewed the records of all 739 patients who underwent FNA of solitary thyroid nodules at our institution from 1988 to 2004. A total of 815 aspirations were required to obtain satisfactory specimens. According to their physicians practice, some patients had a "follow-up biopsy" after an initially benign FNA reading as a matter of routine (Group I approach) or if their clinical status changed (Group II approach). The outcome information for at least 4 years after the initial FNA in these two groups was compared. In addition, hypothetical costs relating to both methods for deciding whether to do a follow-up FNA were considered. The initial FNA was benign in 576 (78%), suspicious for follicular neoplasms in 106 (14.4%), and malignant in 57 patients (7.7%). Follow-up FNA was performed in 292 patients with initially benign lesions, 235 in Group I approach and 57 in Group II approach. The FNA diagnosis according to Group I approach remained benign on follow-up biopsy in 96.2% (226/235), was altered to follicular neoplasm in 3% (7/235), and was suspicious for malignancy in 0.8% (2/235). When following Group II approach, the follow-up FNA was benign in 93% (53/57), undetermined in 1.7% (1/57), and showed follicular neoplasm in 5.3% (3/57). Combining Groups I and II methods, 5 of 292 patients had a malignant nodule on histological examination, a false-negative rate of 1.7% for the initial FNA, but without a difference in prevalence of thyroid malignancy between the groups. Cost-consequence analysis showed no benefit in routine follow-up FNA after initially benign FNA readings. Routine follow-up FNA in patients whose initial FNA is benign has a low diagnostic upgrading value and is relatively costly. In patients whose initial FNA is benign, we recommend the FNA be repeated only if clinically suspicious signs or complaints develop.

Role of Apparent Diffusion Coefficient Values in Differentiation Between Malignant and Benign Solitary Thyroid Nodules

Accurate imaging characterization of a solitary thyroid nodule has been clearly problematic. The purpose of this study was to evaluate the role of the apparent diffusion coefficient (ADC) values in the differentiation between malignant and benign solitary thyroid nodules. A prospective study was conducted in 67 consecutive patients with solitary thyroid nodules who underwent diffusion MR imaging of the thyroid gland. Diffusion-weighted MR images were acquired with b factors of 0, 250, and 500 s/mm(2) by using single-shot echo-planar imaging. ADC maps were reconstructed. The ADC values of the solitary thyroid nodules were calculated and correlated with the results of histopathologic examination. Statistical analysis was performed. The mean ADC value of malignant solitary thyroid nodules was 0.73 +/- 0.19 x 10(-3) mm(2)/s and of benign nodules was 1.8 +/- 0.27 x 10(-3) mm(2)/s. The mean ADC values of malignant nodules were significantly lower than those of benign ones (P = .0001). There were no significant differences between the mean ADC values of various malignant thyroid nodules, but there were significant differences between the subtypes of benign thyroid nodules (P = .0001). An ADC value of 0.98 x 10(-3) mm(2)/s was proved as a cutoff value differentiating between benign and malignant nodules, with 97.5%, 91.7%, and 98.9% sensitivity, specificity, and accuracy, respectively. The ADC value is a new promising noninvasive imaging approach used for differentiating malignant from benign solitary thyroid nodules.

The 'dark nucleus' and disruptions of follicular architecture: possible new histological aids for the diagnosis of the follicular variant of papillary carcinoma of the thyroid.

In order to facilitate the diagnosis of malignancy in solitary thyroid nodules which are non-invasive low-grade tumours, i.e. follicular variant of papillary carcinoma (FVPC) for which few histological discriminators exist, a search was made for additional diagnostically useful histological features. Haematoxylin and eosin (H & E)-stained sections of 70 resection specimens of solitary thyroid nodules were re-evaluated by a panel of three pathologists, and their consensus and original diagnoses compared. In addition, H & E- and periodic acid-Schiff-stained sections were evaluated for various histological features and sections were stained by various immunohistochemical markers to evaluate their discriminative powers. The above features were also assessed in a group of 24 papillary carcinomas of the thyroid (PTCs) associated with regional metastases. The finding of 'Orphan Annie eye' nuclei was the best indicator of malignancy, and was closely related to the presence of nuclear grooves and cells with dense, dark nuclei. In addition, distorted follicular architectural features, i.e. 'interconnecting cell masses' and 'fenestration', were also significant indicators of malignancy. Tumours diagnosed as FVPCs had a significantly lower incidence of associated lymph node metastases than the classical PTCs. The use of optically clear nuclei as a diagnostic criterion when found only focally may not be sufficiently stringent in distinguishing FVPCs from follicular adenomas. When classical histological indicators of malignancy are equivocal, the diagnosis of FVPC may be facilitated by the above-mentioned features.